Page 93 - International guidelines for groin hernia management

Hernia

Key question a wound protector was used at time of bowel resection and
the area was lavaged with saline following bowel resection.
KQ21.g In patients with intestinal strangulation and/or A low-quality systematic review with meta-analysis has
concurrent bowel resection (clean-contaminated surgical been published and suffers from a number of flaws but
field) is mesh-based repair recommended. Which mesh? represents the only SR that examines whether mesh repair

Evidence in literature is associated with a higher surgical site infection risk when
One well-done cohort study with a prospective analysis of compared with non-mesh techniques. 326 The SRs authors
Lichtenstein repairs in clean-contaminated fields (bowel recognize their review’s weaknesses and conclude, ‘‘The
resection vs no bowel resection) showed that acutely mesh repair technique is a good option for the treatment of
incarcerated groin hernias can be safely repaired with non- strangulated IHs in adults, giving an acceptable wound
absorbable mesh (monofilament polypropylene) with an infection rate and fewer recurrences than non-mesh repair.
acceptable wound infection and recurrence rate even when Our study does not allow us to recommend the use of mesh
intestinal necrosis was present. 322 in cases of bowel resection. We emphasize that, except for
Another small low-quality cohort study found no differ- the two RCTs, the results are predicated on patient selec-
ences in morbidity, mortality, or wound- and mesh-related tion by careful surgeons.’’
problems when comparing mesh repair (Lichtenstein) with Information to address the question is insufficiently
Bassini in incarcerated/strangulated hernia repairs requiring available in the current medical literature.
bowel resection. 323 Polypropylene mesh (type unspecified)
was used after copious saline lavage of the surgical field. Discussion
Another cohort study compared mesh (PHS system) There is limited, low-quality evidence addressing the issues
with non-mesh repairs in a mixed clean and clean-con- raised in this question. The statement is, therefore, only
taminated field population and found no differences. 324 weakly supported. Appreciable uncertainty exists about the
Contaminated-dirty field patients were excluded. The study magnitude of benefits and risks. Definitive research is
supported the idea that use of prosthetic mesh in emergent needed on this subject.
hernia repairs is not contraindicated.
A well-done cohort retrospective study compared bowel Key question
resection with no bowel resection groups and concluded that
mesh repair was safe in patients not requiring bowel resec- KQ21.h In stable patients with strangulated obstruction
tion. 325 A further conclusion was that mesh use is not con- and peritonitis caused by a bowel perforation or an abscess
traindicated in patients requiring bowel resection so long as due to necrosis of the omentum (contaminated-dirty sur-
the field is kept clean-contaminated during surgery. Gauze or gical field) is mesh repair recommended. Which mesh?

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